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PubMed1984

Malingering and malingering-like behavior: some clinical and conceptual issues.

Malingering phenomena are reconceptualized along a continuum of other-deceptive, and "malingering-like" mixed-deceptive and self-deceptive categories, depending upon the degree of the subject's conscious self-awareness. This schema heuristically expands the malingering concept to include its multivaried range of clinical presentations which are ubiquitously encountered but underdiscussed in the literature.

Adaptation, Psychological↗

PubMed1997

Detection of malingering: validation of the Structured Inventory of Malingered Symptomatology (SIMS).

This article discusses the development and validation of a paper and pencil screening measure, the Structured inventory of Malingered Symptomatology (SIMS), designed to detect malingering. Test items were constructed from a combination of revised validity questions from existing instruments and characteristics of malingerers noted by existing research. Items were organized on one of five subscales by experienced clinical psychologists. College students (N = 476) were assigned to one of seven simulation conditions (i.e., psychosis, amnesia, neurologic impairment, mania, depression, low intelligence, and "fake bad") or an honestly responding group. All subjects were administered the SIMS, the F and K scales of the MMPI, 16PF Faking Bad scale, and portions of the malingering scale. The SIMS total score demonstrated the highest sensitivity rating (95.6%) for detection when compared with the other validity indices. Suggestions concerning further research using the SIMS as well as its potential utility in a complete evaluation process are discussed.

Adult↗

PubMed1999

Utility of the structured inventory of malingered symptomatology in identifying persons motivated to malinger psychopathology.

The Structured Inventory of Malingered Symptomatology (SIMS) is one of a number of recently developed instruments designed to identify persons exaggerating and/or fabricating psychiatric and cognitive symptomatology. Preliminary analog research indicated that the SIMS showed some promise as a screening device for identifying malingerers. This study examined the utility of the SIMS for identifying malingerers and, more importantly, its ability to distinguish truly symptomatic persons from persons fabricating symptomatology. In a sample of 197 participants who completed the SIMS and Symptom Checklist-90-Revised (SCL-90-R) under both honest and malingering instructional sets, sensitivity and specificity rates were generally high for the SIMS Total score and subscales. However, moderate correlations with the SCL-90-R were obtained in this sample, and specificity rates were lowest among a subset of participants reporting clinically significant levels of distress; both findings raise concerns regarding the potential for high false positive rates among clinical populations. Implications for clinical forensic practice are discussed and recommendations for future research are offered.

Adult↗

PubMed1993

Defrocking the fraud: the detection of malingering.

The purpose of this paper is to provide psychiatrists with practical advice on how to detect malingered mental illness. Various types of malingering are defined and the five major purposes of malingering are specified. The research literature on malingering is reviewed. Clinicians must be thoroughly grounded in the phenomenology of true mental disease to detect malingering. Detailed information about hallucinations is reviewed so that faked hallucinations that do not follow typical patterns can be more easily identified. Strategies for approaching persons suspected of malingering are suggested. Features of malingered mutism, mania, depression and mental retardation are described. The differential diagnosis of malingering, post-traumatic stress disorder, conversion disorder, and post-concussion syndromes after trauma is discussed. Clues to malingered psychoses and post-traumatic stress disorders are delineated. Finally, specific indicators of malingered insanity defenses are identified.

Depressive Disorder↗

PubMed2003

Daubert, cognitive malingering, and test accuracy.

Daubert v. Merrell Dow Pharmaceuticals (1993) held that trial judges should permit expert scientific testimony only when "the reasoning or methodology underlying the testimony is scientifically valid, and ... properly can be applied to the facts in issue." Vallabhajosula and van Gorp ("V & vG," 2001) have suggested that when the Daubert standard is applied to tests for malingered cognitive deficits, courts should deem admissible only results that meet this mathematical standard: assuming a pretest probability of .3, a "positive" score on the malingering test should yield a posttest probability of at least .8. This paper shows that V & vG's criterion may lead to misunderstandings about the kind of information maligering measures provide. After reviewing cases that have discussed both the Daubert decision and malingered cognitive deficits, this paper uses data from the Test of Memory Malingering (T.N. Tombaugh, 1996) to provide a general characterization of the mathematical properties of malingering measures. The paper then describes how pretest knowledge about malingering is combined with knowledge about a test's performance to generate a posttest probability of malingering. The results can help mental health experts respond to Daubert-inspired challenges to conclusions based on malingering measures.

Bayes Theorem↗

PubMed1997

The malingering of multiple sclerosis and mild traumatic brain injury.

In this investigation, neuropsychological testing was conducted with 69 college students that were instructed to malinger either multiple sclerosis (MS) or traumatic brain injury (TIB) or were non-malingering controls. The two malingering groups were divided into informed and non-informed groups. The informed groups received information concerning their respective condition, and the non-informed groups were asked simply to malinger. Generally, all malingering groups performed considerably below the levels of non-malingering controls on measures of attention, learning and memory, word fluency, abstract reasoning, visuoconstruction and manual dexterity. There appeared to be no difference in the manner in which subjects attempted to malinger MS as opposed to TBI. However, the severity of the portrayed deficit suggested by the test scores was disproportionate to the severity of the injury being requested. The pattern of deficit presented was quite global, with well below average performance demonstrated by all malingering groups across all domains.

Adolescent↗

PubMed1998

Cognitive complaints in patients after whiplash injury: the impact of malingering.

OBJECTIVES: The validity of memory and concentration complaints that are often reported after a whiplash trauma is controversial. The prevalence of malingering or underperformance in post-whiplash patients, and its impact on their cognitive test results were studied. METHODS: The Amsterdam short term memory (ASTM) test, a recently developed malingering test, was used as well as a series of conventional memory and concentration tests. The study sample was a highly selected group of patients, who were examined either as part of a litigation procedure (n=36) or in the normal routine of an outpatient clinic (n=72). RESULTS: The prevalence of underperformance, as defined by a positive score on the malingering test, was 61% (95% CI: 45-77) in the context of litigation, and 29% (95% CI: 18-40) in the outpatient clinic (p=0.003). Furthermore, the scores on the memory and concentration test of malingering post-whiplash patients (n=43) and non-malingering post-whiplash patients (n=65) were compared with the scores of patients with closed head injury (n=20) and normal controls (n=46). The malingering post-whiplash patients scored as low as the patients with closed head injury on most tests. CONCLUSIONS: The prevalence of malingering or cognitive underperformance in late post-whiplash patients is substantial, particularly in litigation contexts. It is not warranted to explain the mild cognitive disorders of whiplash patients in terms of brain damage, as some authors have done. The cognitive complaints of non-malingering post-whiplash patients are more likely a result of chronic pain, chronic fatigue, or depression.

Adult↗

PubMed1998

Malingering assessment in behavioral toxicology: what, why, and how.

Neurobehavioral assessment is frequently made in a forensic context. The cognitive assessment may be biased due to an international manipulation of data by the patient motivated by attainment of compensation, that is, malingering. Although malingering is highly relevant in behavioral toxicology, the issue and its assessment are underrepresented in the literature. A routine assessment of malingering is important to reduce false-positive and false-negative errors in assessment, thereby establishing the credibility and validity of behavioral assessment. In the long run, the routine inclusion of malingering measurements might reduce claims and encourage employers to be more cooperative in behavioral toxicology studies. Guidelines for malingering assessment and research, inferred from the clinical and research literature, are discussed. Sensitivity to the problematic issues involved in assessing malingering behavior is an important step toward malingering detection in the clinical setting and to the establishment of assessment methods that are less confounded by these issues.

Behavior↗

PubMed1999

How well do standard clinical neuropsychological tests identify malingering? A preliminary analysis.

Neuropsychological research has primarily focused on identification of malingerers through specialized tests designed for this purpose. Little attention has been given to the degree to which traditional clinical measures differentiate between malingerers and non-malingerers. This study examined the neuropsychological performance of 81 subjects who had a history of mild to moderate head injury, some of whom are believed to have been motivated to malinger their test performance. Subjects were classified as malingerers or non-malingerers based on their history as well as their performance on specific neuropsychological malingering tests. Performance on traditional neuropsychological clinical measures was examined for both groups. Results indicated that subjects' pattern of neuropsychological performance was not a reliable indicator of malingering performance, supporting the notion that specialized malingering tests are a critically necessary component to clinical classification of malingering. However, level of performance may provide an indication of malingering, as probable malingerers consistently performed worse on traditional and clinical neuropsychological measures. These findings are discussed in the context of the malingering literature.

Adult↗

PubMed1999

Current issues in the diagnosis and management of malingering.

Malingering is a diagnosis that is frequently avoided by physicians. When there is a claim of symptoms or diseases that either are exaggerated or do not exist, the diagnosis of malingering should be entertained. Malingering is associated with a conscious intent to deceive in order to obtain a known gain. Psychoanalytical, criteria-based (DSM-IV) and 'adaptational' models have been advanced to explain malingering. The differential diagnosis of malingering includes factitious disorder, the somatoform disorders, the dissociative disorders, and specific medical conditions without somatoform disorder. Upon consideration of the differential diagnosis, confirmation of the suspicion of malingering is still required in order to make the diagnosis. Confirmation can be achieved by observation or by inferential methods. Observation can be employed with controlled environment observation or with covert, 'real-world' surveillance; inference may involve primary and/or secondary source information. It may be concluded that a greater attempt should be made to identify this diagnosis, as the cost of malingering to society is considerable.

Diagnosis, Differential↗

PubMed2002

Novel cases: malingering by animal proxy.

Malingering to obtain medications of abuse is well documented in the general medical setting. However, we have found no cases previously reported of such malingering in a veterinary setting. We report five cases submitted by veterinarians in which clients (pet owners) are strongly suspected or confirmed to have been engaging in malingering to obtain controlled medications for their personal use. Cases bear a striking resemblance to malingering in the general medical setting for drugs to abuse. We propose that veterinarians, like their medical counterparts, are potential targets of malingering by their clients for drugs of abuse. Because of their familiarity with this condition, psychiatrists may have a role in training veterinarians to recognize malingering on the part of their human clients. In addition, psychiatrists may benefit from familiarizing themselves with novel forms of malingering, such as are presented in this case series.

Adult↗

PubMed1983

A review of ocular malingering and hysteria for the flight surgeon.

Malingering is the conscious creation of a functional defect or denial of a true defect. Positive malingering is the former, and negative malingering is the latter. Hysteria is similar to malingering except that it is unconscious. Ocular malingering is common among draft evaders. The flight surgeon or military ophthalmologist will more commonly see the negative malingerer in peacetime because of the high physical standards for flying. Wartime creates a sudden shift towards positive malingering, however, for obvious reasons. This paper carefully defines the distinctions between malingering, hysteria, and true disease consistent with the defect claimed. It also provides a systematic approach to history, examination, and special testing of a possible ocular malingerer/hysteric. A number of common ocular complaints are considered separately, including decreased visual acuity, visual field defects, night vision defects, color vision defects, ocular muscle defects, automutilatory defects, opacification of transparent media, blepharospasm, intraocular disease, and asthenopia.

Aerospace Medicine↗

PubMed1998

Prevalence of malingering in inpatient suicide ideators and attempters.

The purpose of the present study was to ascertain the prevalence of malingering by inpatients admitted to an urban hospital for suicidal ideation or attempt. Fifty-eight consecutively hospitalized suicidal patients were asked to participate, and of these 40 (70%) agreed to do so. Each patient was given an anonymous questionnaire asking whether they had lied or purposely exaggerated suicidal ideation to gain admission. A psychiatrist and masters-level psychologist, both blind to the patient responses, then rated each patient for suspicion of malingering. Each patient was also administered the MMPI-2 F, L, and K validity scales. Four patients (10%) indicated they had malingered and indicated that external incentives had motivated them to feign either suicidal ideation or a suicide attempt. None of the MMPI-2 validity scales correlated with self-reported malingering. The clinicians detected malingerers with 100% sensitivity, but the specificity rates were only 58% for the psychiatrist and 32% for the psychologist. The results indicate that some inpatients malinger about the extent of their suicidal intentions. The data demonstrate the difficulty inherent in detecting malingering by clinical interviewing and psychological testing.

Adult↗

PubMed2003

Utility of the trail making test in the assessment of malingering in a sample of mild traumatic brain injury litigants.

The Trail Making Test (TMT) is one of the most commonly administered tests in neuropsychological assessments. It has been shown to be a valid indicator of brain damage due to traumatic brain injury (TBI), as well as a number of other neuropathological conditions. TMT error and ratio scores have been suggested as possible markers of malingering. The present study examined the utility of various TMT scores as malingering measures in 94 TBI litigants. Litigants were divided into those suspected of (n = 27) and those not suspected of malingering (n = 67) based on scores obtained on the Test of Memory Malingering and/or the Rey 15-Item Test. TMT errors did not discriminate between suspected and nonsuspected malingerers; however, the overall level of performance on the TMT was suppressed in suspected malingerers. The TMT ratio score was significantly lower in litigants suspected of malingering, although the clinical utility of this ratio is minimal. Results of the present study suggest using caution when interpreting TMT scores as markers of malingering in TBI litigants.

Adult↗

PubMed2003

An emotional Stroop effect to malingering-related words.

This study was designed to elicit an emotional Stroop effect in simulators of malingering. Student participants (mostly women) either did or did not feign mild brain trauma. A modified Stroop test was administered, using neutral and "malingering" words. Controls showed no difference on malingering versus neutral words; simulators performed significantly worse on malingering words. Further research must specify the best method of administration to elicit a malingering Stroop effect and assess the additional discriminative power it may provide when combined with other malingering-detection strategies.

Adult↗

PubMed2000

The meaning of malingering data: further applications of Bayes' theorem.

A previous Behavioral Sciences and the Law article (Mossman & Hart, 1996) asserted that information from malingering tests is best conceptualized using Bayes' theorem, and that courts therefore deserve Bayesian interpretations when mental health professionals present evidence about malingering. Mossman and Hart gave several examples of estimated Bayesian posterior probabilities, but they did not systematically address how one constructs confidence intervals for these estimates. This article explains how the usually imperfect nature of humanly created diagnostic tests mandates Bayesian interpretations of test results, and describes methods for generating confidence intervals for posterior probabilities. Sample calculations show that Bayesian reasoning is quite feasible and would not require investigators to expend unusual efforts when constructing and validating malingering instruments. Bayesian interpretations most accurately capture what malingering tests do: provide information that alters one's beliefs about the likelihood of malingering.

Attitude to Health↗

PubMed2001

The relationship between psychopathic personality features and malingering symptoms of major mental illness.

This study examined the relationship between psychopathy and malingering in a subsample of male prison inmates (n = 55) participating in a larger study of the clinical utility of various assessment measures in correctional settings. Participants' capacity to feign major mental illness successfully was evaluated using standard cutoff scores for the detection of malingering on a variety of instruments, including the Structured Inventory of Malingered Symptomatology (SIMS; G. P Smith & G. O. Burger, 1997), the Structured Interview of Reported Symptoms (SIRS; R. Rogers, R. M. Bagby, & S. E. Dickens, 1992), and the Personality Assessment Inventory (PAI; L. Morey, 1991). Psychopathic traits were assessed via the Psychopathic Personality Inventory (PPI; S.O. Lilienfeld & B. P Andrews, 1996). Correlations between the malingering indices and the PPI were low (-.14 to .14) and not statistically significant. These findings fail to support the clinical intuition that individuals with higher levels of psychopathy are likely to be more adept at malingering.

Adult↗

PubMed2001

Base rate of a WMS-R malingering index in a sample of non-compensation-seeking men infected with HIV-1.

HIV-1 infected persons who are pursuing disability benefits are increasingly seeking neuropsychological assessment for purposes of corroborating functional impairment. Thus, research on the utility of measures of symptom validity among these patients is needed. Recently, Mittenberg, Azrin, Millsaps, and Heilbronner (1993) proposed a malingering index score for the WechslerMemoryScale-Revised that is derived by subtracting the Attention/Concentration Index (ACI) score from the General Memory Index Score (GMI). This study is a cross-validation of the specificity of the GMI-ACI Malingering Index in a sample of 55 non-compensation-seeking HIV-positive (HIV+) patients. An overall false-positive rate of 7% was observed for the GMI-ACI Malingering Index. However, further analyses showed that GMI-ACI Malingering Index scores were correlated with GMI scores such that false-positive errors were substantially higher (18%) among patients who obtained above-average GMI scores. These findings suggest a cautious approach to application of the GMI-ACI Malingering Index, particularly among patients who obtain above-average GMI scores.

Adult↗